Friday, November 14, 2014

Media Forum: Results of ADVANCE-ON Study on Intensive Glucose-Lowering Treatment (World Diabetes Day 2014)

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Diabetes is a disease condition characterized by elevated blood sugar levels. This is due to deficiency or lack of insulin which is needed to utilize blood sugar.

In the Philippines, diabetes is considered one of the leading cause of death among Filipinos. Ranked at #8, in 2004-2008 data showed there 22 Filipinos died of diabetes and its complications for every 100,000 population. In 2009, it rose to 24 and possibly rising due to major risk factors such as lifestyle, diet, sedentary habits, excessive smoking and consumption of alcohol and hereditary predispositions, among others.

Complications of diabetes are: cerebrovascular diseases, retinopathy, heart disease, nephropathy, neuropathy, peripheral vascular disease in the lower limbs, ulceration and amputation for diabetic foot.

Diabetes, however, is a controllable and preventable disease through lifestyle modifications and the correct medications.

In a media forum (in observance of the World Diabetes Day 2014) held last November 12, 2014 at the EDSA Shangri-la Hotel, presented to the public was the result of this worldwide long-term study which aimed to assess the effects of intensive glucose and blood pressure control of major vascular outcomes in a broad cross-section of patients with type 2 diabetes through the ADVANCE and ADVANCE-ON.

What is ADVANCEAction in Diabetes and Vascular Disease PreterAx and DiamicroN MR Controlled Evaluation, was one the largest morbidity-mortality trials conducted in type 2 diabetes. ADVANCE is an investigator-initiated trial designed, conducted, analyzed, and interpreted independently of sponsors. Median duration of follow-up was 5 years.

The Philippines, with four (4) accredited testing centers was among the 20 countries where the study was conducted for more than 10 years period and covered 11,140 patients aged 55y old and above. The four centers are: Philippine General Hospital led by Dr. Mary Anne Lim-Abraham; East Avenue Medical Center – Dr. Maria Teresa Plata-Que; Makati Medical Center – Dr. Augusto Litonjua; and at the Institute for Studies on diabetes Foundation – Dr. Araceli Panelo.

What is ADVANCE-ONAction in Diabetes and Vascular Disease PreterAx and DiamicroN MR Controlled Evaluation – Post Trial ObservatioNal Study. A post trial follow-up study involving all surviving patients from the ADVANCE trial for another 5.9 years (median).

Results proved that long-term intensive glucose control based on a gliclazide-modified release strategy among diabetes patients may create a major impact on the reduction of kidney failure. According to leading researchers of the ADVANCE-ON Post-trial Observational Study, an intensive glucose-lowering treatment is likely to produce major long-term benefits for the kidneys.

With this strategy, diabetes patients may have lower risk of renal failure that requires dialysis or transplantation. Researchers also note that patients did not experience any increase or decrease in the risks of death as well as any cardiovascular disease.

The findings highlight the importance of active and effective blood glucose management for renal protection in patients with type 2 diabetes. According to the study director and first author Associate Professor Sophia Zoungas, of the George Institute for Global Health at the University of Sydney, among patients with long standing type 2 diabetes, blood pressure-lowering treatment with perindopril-indapamide for an average of 4.5 years resulted in attenuated but significant long-term benefits with respect to death from any cause and from cardiovascular causes, whereas intensive glucose control for an average of 5 years did not provide any long term benefits with respect to death or major vascular events. (Zoungas, S. Follow-up of Blood-Pressure Lowering and Glucose Control in Type 2 Diabetes, The New England Journal of Medicine, Sept 2014).

The ADVANCE-ON research was funded by National Health and Medical Research Council of Australia, the British Heart Foundation, Diabetes UK, and Servier International

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